What to expect and consider
Frequently asked questions
and important answers.
Q & A
Understanding Teen Behavior
We like to avoid the use of the word “normal”, a term that is culture bound and oftentimes stigmatizing for those who might feel different. We prefer to use the word “typical” when we evaluate behavior and how it applies to adolescents. Many changes in adolescent behavior are expected and healthy in teenagers.
Adolescence is a developmental period of individuation, moving away from caregivers and forming bonds with peers and possibly pursuing romantic connections. The role and influence of peers typically becomes primary and incredibly important as adolescents seek to become more independent from caregivers. With significant hormonal and body changes, mood regulation can be more challenging and sensitivity and reactivity can increase. This is also a period of identity seeking: trying on new styles of dress and presentation, discovering music, art, media, and hobbies.
We typically become concerned about an adolescent when things like irritability, anger, sadness, substance use, defiance, and other behaviors become more frequent, more intense, and last longer. Think of it in terms of Frequency, Intensity and Duration: How often is this happening? How significant is the behavior? (saying something back to you versus yelling or screaming) How long does the behavior last? (yelling a response versus yelling for an hour)
Eg:
My child occasionally refuses to do something and now pushes back/argues about everything.
My child normally sleeps 8 hours and now does not want to get out of bed.
My child stays up all hours of the night and does not sleep often in the day.
My child refuses school every day.
My child is smoking pot every day.
My child cut themselves once and now is cutting multiple times a week.
My child cries frequently.
My child complains of stomach aches frequently.
We refer to the acronym ADLs, or Activities of Daily Living, and ask that you monitor things such as: How is your child functioning? Are they completing hygiene, getting regular sleep, and eating regularly? What is their school performance like? What is their own self-report of how they are feeling – are they disclosing they are anxious, sad, depressed, angry?
If you notice changes in your child’s behavior, it is important to talk to them first. Share what you observe and be curious. Establishing regular times for communication and checking in is important as well as establishing intentional time where you are present together.
It is also important to connect with teachers, school counselors, coaches, or other people in your child’s life to compare your own observations and let them know what you are seeing. Your child will often share their most intense behaviors with you because it is common for them to feel safe with you and finally be themselves when they get home each day. However, when these behaviors impact multiple relationships in their lives, and cause issues in various realms (school, law, social, hobbies, etc) then there may be more significant challenges present for your child.
Before you send your teen to a program
It can be really hard to know when you have reached the breaking point. Ultimately, it is up to you, your family, and your child. If you feel more and more that your child’s safety is compromised, that you can’t ensure safety, and that symptoms and behaviors are increasing in intensity and frequency, it may be time to consider a therapeutic program. Other signs that indicate it may be time to increase involvement with your child include: multiple hospitalizations, lack of positive results from other local supports, increased resistance, or if you’ve been feeling stuck or feel like the situation keeps declining.
Asking feedback and observations from other members of your community or professionals can provide insight. It may also be helpful to talk to other parents who have children in therapeutic programs (contacts can be accessed through admissions offices) to ask them about their decision-making process before they admitted their child.
Sometimes You can ask yourself if you believe your child would benefit from being out of the house and away from the stresses that they are struggling with. Therapeutic programs provide more comprehensive options for therapy in a group setting with children also struggling. It is a difficult decision to make and every situation is unique.
After exhausting more local options, oftentimes the next step is for families to consider out-of-home treatment. Generally, the options are either wilderness therapy, residential treatment, or therapeutic boarding school. Frequently, wilderness therapy is the first stop — a helpful gateway and assessment tool before being placed into another longer-term treatment center. Other times, families skip wilderness and place their child in longer-term residential programs right away.
Every child has a unique combination of strengths and needs, and it can be hard to discern which program is the best fit. This is why going into depth with the admissions counselor at each program you are considering is so important. Being honest around describing your child’s challenges and behaviors with the admissions department is crucial, as well as tracking what therapeutic modalities have already been used (and what was helpful and what wasn’t) because some programs utilize specific types of therapy that may or may not be the right fit.
Ask yourselves and your family: Is it valuable to have an outdoor education and adventure recreation component? Do we prefer co-ed or single gendered? What kind of academic programming is best? (Some have in-person instruction with teachers while others have online schooling). Is geography a factor? How independently can my child function or do they need heightened security and supervision?
Click here for additional questions to ask admissions in assessing which program is the best option for your kid.
Youth of color are very underrepresented in the world of outdoor behavioral health and general mental health access and treatment. Some of this is related to systemic racial, socioeconomic, and cultural barriers and factors. For those who are attending a program, it may feel isolating or uncomfortable to be one of the few children of color in a program. Treatment may not be as supportive if it is not culturally or racially responsive and healing will need to address the racism and discrimination experienced that are often factors in mental health symptoms. However, it will likely be difficult to find information about culturally responsive treatment but Here are some questions to ask admissions in your assessment.:
-What is the demographic and ethnic breakdown of the youth you serve?
-What are the demographic and ethnic breakdowns of staff?
-What trainings are required by staff regarding cultural humility and/or anti-racist practices such as unconscious bias training?
-Does your academic curriculum provide a diverse education and support anti-racist practices, history, and critical thinking skills?
-Have there been incidents of racism and/or bullying related to race, color, and culture? If so, how were these incidents handled?
-Are your services provided in other languages?
-What educational and language supports are provided for students who speak English as a second language?
-What traditions and holidays are celebrated?
-How are students supported in celebrating a holiday or tradition that is not a part of the programming?
-What is the campus culture for students with _____ background?
-Do you have a diversity statement?
Asking direct questions about gender-affirming and LGBTQ-friendly programming will be very important in your assessment if your child either identifies as non-binary, gender non-conforming, and/or LGBTQIA+ or if you want a program that emphasizes and supports such programming and culture. Only a few programs advertise as explicitly gender-affirming or LGBTQIA+ friendly, so you may have to do some digging to determine if programs you are interested in meet your needs. Sometimes, their policies will make it very clear; other times, it will not. It may be difficult to find programs that are truly affirming and centering of non-binary, gender non-confirming, and LGBTQIA+ youth.
Likely, your child will be the most up to date around current needs and culture to best support gender non-conforming youth. Depending on your relationship, they may be a great resource in learning how and what to look for.
Some ideas of questions to ask programs include:
-How important is it for the program to serve, support, and center non-binary or LGBTQIA+ youth?
-Does your curriculum include any queer studies, gender studies, or history of LGBTQIA+ rights?
-What policies exist around preferred names instead of legal names given at birth?
-Can youth be addressed by their preferred gender or gender-neutral pronouns?
-What trainings are provided or required for staff to be up to date with best practices in supporting non-binary and LGBTQIA+ youth?
-What housing arrangements are made for transgender or gender non-conforming students?
-What incidents of homophobia and/or transphobia have occurred? How have they been handled and responded to?
This will absolutely be a part of the discussion when talking with the admissions team, as education is a necessary component to your child’s life and their treatment.
However, programs have differing emphases on education. Some have in-person instruction and teaching while others have online schooling.
Some children start therapeutic programs needing credit recovery (which many programs provide), some youth are on pace with their education, and others may wish for a more rigorous curriculum, possibly with college preparation support.
Therapeutic boarding schools tend to have a stronger emphasis on academics with higher likelihood for in-person instruction, while residential treatment has a stronger focus on therapy and stabilization and are more likely to rely on virtual learning.
It really depends on what your child’s current needs are and which programs seem like the overall best fit.
Here are some questions to ask the admissions counselor when doing your assessment.
-Is education in-person or internet/computer-based? If you have teachers on site, are they certified or licensed within the state? How many times a week do they hold in-person instruction? How many students are in a class?
-Do you provide an academic curriculum? If so, what is the core curriculum?
-Are there credit recovery options?
-Are high school diplomas granted?
-Do these credits transfer to other academic institutions?
In our directory, we’ve included Cognia in our search terms. Cognia, previously AdvancED, is an accreditation body providing voluntary oversight and educational standards to academic implementation and quality. It is the largest accreditation body of educators in the world. Like many of the third-party non-profits that create their own standards, it cannot fully promise the most absolute rigorous programming. However, this does provide additional support and guidelines to schools and facilities that have an educational component, and like the other accreditation bodies, can be a tool to discern which program fits the needs of your child. There are many other educational accreditation bodies as well as different regional and national accreditations.
About Therapeutic Education Consultants
Therapeutic education consultants (TEC) are typically licensed professionals that refer children and adolescents experiencing mental health disorders and other closely related disorders to the most appropriate treatment programs, mental health professionals, and coaches. TECs have varied backgrounds, often in behavioral therapy, counseling, mental health, addiction, and/or youth interventions. They will have strong connections with therapists and psychiatrists, residential and outpatient centers, wilderness programs, and aftercare programs.
Therapeutic educational consultants typically spend sizable amounts of time touring and viewing treatment centers and meeting with professionals in their region.
The most important criteria, in our opinion, is that they are working for you and receive no incentive fee for placement at a specific school or program. The best TECs have visited the programs they are recommending and know the leadership who run them and work there. The TEC should spend enough time with your family to understand your specific needs in order to recommend the appropriate level of care and placement.
Therapeutic education consultants may charge from $85 to $200 per hour and up to $4000 to $11,000 per hour. In our experience, just because a consultant is more expensive does not mean they are better. The experience is driven by the individual consultant’s style and knowledge. While we list some consultants on our site, we do not make recommendations on which consultants to choose. Spend some time researching; sometimes the best reference is another parent recommendation.
The short answer is – no. You can, of course, do your own research, speak with the programs, and ask to visit. That said, education consultants can be helpful in guiding you to the programs that are likely to be the best fit for your child and which programs have space etc.
- What specific services do you provide?
- How much do you charge for your services and time?
- What training and educational credentials have you obtained?
- Which disorders do you specialize in? Psychiatric disorders? Addictions? Eating Disorders? Learning disorders? etc.
- What is your availability right now to work with my family?
- What are the payment options of the treatment professional and programs you’ll refer us to?
- Ask yourself if the consultant’s personality and philosophy style will mesh with you and your child. Consider how attentive they will be able to be according to their schedule.
Paying for a program
These programs are expensive and, unfortunately, at least to date, most insurance companies will cover only a small amount of the cost (usually only specific periods that can be attributed to therapy with a professional). The costs vary, but you can expect to pay somewhere between $9,000-$12,000 per month – often around $500 a day. These costs cover everything such as food, supplies (except your child’s personal belongings like clothing clothing), and intensive individual and group therapy.
Many programs have a staff member to help you with insurance., We highly suggest that you discuss insurance options when assessing different programs. .
Accredited residential treatment centers and therapeutic boarding schools are considered “out-of-network treatment providers.” Coverage varies by plan, but often insurance providers will cover “crisis services” for the first thirty days of treatment. You may have to cover either partial or full treatment for the remainder of services. It is necessary to know the licensing and accreditation of the program for insurance purposes as well.
Many private or employer paid insurance companies offer mental health benefits and coverage for: residential treatment (RTC), partial hospitalization (PHP), intensive outpatient (IOP).
Other funding options are fairly limited. For most families, a significant portion will need to be paid out of pocket for these programs.
However, there are various organizations that offer scholarships and funding for specific types of programs and recipients.
Sky’s the Limit Fund is a scholarship foundation to help youth access wilderness therapy programs based on the family’s financial need.
If a family can prove that their child was a victim of a serious crime, the National Association of Crime Victim Compensation Boards (NACVCB) can provide funds for therapeutic boarding schools or other services. To be eligible for NACVCB support, parents must prove that the crime was reported to the police and has a case number. This crime is not required to have gone to trial or resulted in conviction.
The Adoptive Families Coalition is a non-profit that can help pay therapeutic boarding school tuition of adopted youth.
Examples of other ideas to help offset costs include:
-Go FundMe or other crowd-sourcing fundraising
-Financial assistance from churches or other community networks
-Certain Veteran benefit programs that help veterans take out low-interest personal loans
-Personal loan from a bank
-Low interest or zero-interest credit card
-Taking out a second mortgage
-Savings accounts reserved for children’s education
Trustworthy programs
This is a hard question to answer. You know your child best. Do your homework – ask to speak with parents who have children currently at the program or whose children have graduated fro the program. Ask lots of questions from the program staff. Visit if you can. Trust your gut. And do check any accreditation or memberships with nationally recognized organizations.
Yes. We believe strongly that it does matter. Accreditation is not a guarantee that it is the right program for your child though. Accreditations standards and regulations vary from state to state but there are a few organizations that accredit organizations nationally. The organizations that we have included in our Directory do not all accredit but are generally considered reliable organizations in the space: the National Association of Therapeutic Schools and Programs (NATSAP); the Outdoor Behavioral Health Council (OBHC); The Joint Commission; Council on Accreditation (COA); and Commission on Accreditation of Rehabilitation Facilities (CARF).
Because of the widely varying requirements from state to state, these accreditations and memberships are one tool to assess for safety and efficacy.
The National Association of Therapeutic Schools and Programs (NATSAP) does not accredit. NATSAP is a membership organization that provides resources, puts on conferences, and encourages advancement and best practices. NATSAP requires each member “to be licensed by the appropriate state agency authorized to set and oversee standards of therapeutic and/or behavioral health care for youth and adolescents or accredited by a nationally recognized behavioral health accreditation agency and to have therapeutic services with oversight by a qualified clinician.” (https://natsap.org)
For wilderness therapy, OBH joined with Association for Experiential Education (AEE) to outline standards, procedures, risk management, and ethical guidelines for programs to follow. To join OBH, the program must be accredited by AEE within 2 years of joining.
In addition, some accredited programs are members of the Sky’s The Limit scholarship program that can help fund wilderness programs.
In general, these programs often have high turnover rates, as the work is challenging and often underpaid. Many of the folks working in this field do it because they care and have the drive to support youth despite the taxing nature of the work.
Another forefront part of discerning the quality of these programs are standards for safety.
Questions to ask to better understand the quality of program staff include:
-What is the staff-to-student ratio?
-How long have the therapists been employed at the program?
-How many of the therapists are licensed?
-What is the average length of stay for the residential counselors working at the program?
-What kind of training is provided and required of staff?
-What kind of evaluation process do you have for employees?
-Do you perform background checks?
-What would you say is the hardest part of working for this program?
-What is the best part of working for this program?
-What are your safety protocols?
-Who do you report to when safety is mismanaged?
-Would you recommend this program to your friends and family?
This may be one of the most challenging questions to both ask and answer. Generally, yes, these programs are safe, and there are many guidelines and structures to maintain safety. That said, staff quality and experience vary. Most programs will physically restrain children if they believe it is necessary for the safety of the child or those around them. Be sure to ask what those practices are. Programs can choose not to accept a child they deem to be an undue risk or feel they are not equipped to monitor adequately, for example.
There has been increased media reporting around harm, and even deaths, at certain programs. It is worth noting that there is by far more coverage around traumatic experiences than positive experiences. This is part of the importance of committing to thorough assessments of any program you are considering Ask about safety measures, surveillance, staff training, accreditations, and other elements. Although many of these injuries and deaths could have been prevented, keep in mind that for many youth making risky decisions, safety at home is not ensured either.
It is honestly very confusing trying to figure out the various accreditations. Because there are no federal regulatory standards, the only national bodies provide guidelines (although NATSAP has recently announced that they will require all members to be accredited by 2025) for care. Regional accreditation generally provides more oversight and detailed guidelines for programs. That said, not all states or regions have regional accreditations which is why your search for programs may not only entail identifying programs with regional accreditations.
Here are a few links explaining accreditation in a little more detail.
https://www.edsmart.org/regional-vs-national-accreditation/
https://www.indeed.com/career-advice/career-development/national-vs-regional-accreditation
https://www.allkindsoftherapy.com/blog/accredited-vs-nonaccredited-oh-my
Once your child is in a program
It can be very disorienting for your child to live out of the house for a while. Maybe it feels both relieving and sad. Feelings of guilt and shame are completely normal as well. It can be a time for your own pause, reflection, and processing. Many parents find their own therapist or seek couples counseling to address the potential strain on their relationship. It can be hard to plan for the future with the individualized nature of many of these programs, which may feel frustrating.
It can also be a time to refocus on other siblings in the house. It is common for the siblings of a child in crisis to experience vicarious trauma, or perhaps feel neglected while the focus has been on the child with more external or problematic behaviors.
There is likely family involvement either required or encouraged by the program while your child is away. Maintaining communication and involvement is important for the healing of your child and family.
Maybe you want a break away from researching next steps, or maybe you are already looking for what’s next after the current placement. Finding community can be imperative to the healing process.
Join a forum of parents whose children are also currently out of the home in our Community section to connect with others!
Although sending your child is a significant commitment, and there will likely be timeline expectations and contracts, if it truly does not feel like the right fit then you have options to cease treatment. You do have the ultimate choice in what’s right for you and your child.
If there are incompatibilities, and the program agrees that this placement is not the right fit, then there will be a mutually agreed termination of treatment and planning for next steps.
Sometimes, programs will recommend your child continue even if it doesn’t feel right. This can be tricky. Do you trust these professionals or your own parental instinct? Do you wait a little longer to see if things smoothen out? These programs can be challenging for children and it is common for them to ask to return home or to switch to a different program. Validating this desire and the frustration of being there is important, without trying to protect them or rescue them from discomfort. Teenagers often struggle with authority figures; this is normal. However, what’s not normal is if there is reporting of significant power dynamics or assertions of power in a demeaning or aggressive way that are harmful and/or getting in the way of effective treatment.
As a parent, you can request meetings with the providers and key team members. You will likely be in contact with program providers throughout treatment; however, you can also advocate for further meetings to discuss your questions and concerns.
togetherly is built on the premise of community and information which brings support and encouragement to advocate for what you and your family need through these stressful times.This can feel like an uphill battle, but leaning on the support of community and information can equip you with skills to navigate better and find the right support for you and your child.
First, it is helpful to study the system and services, and specifically what they do and do not provide. Does it link up with the needs of your child? What is their main treatment emphasis, and how do they approach it?
Research the diagnosis or diagnoses given, and see if it makes sense. Even getting your own copy of the DSM-V. Diagnosis can be helpful in receiving treatment and getting an organized understanding of symptoms and behaviors. However, they can also be misapplied or confining. A diagnosis will follow your child through any medical treatment and should not be taken lightly. See if it makes sense for you and your child.
When you meet with a mental health professional, have a goal in mind. Your and/or your child’s goal should be embraced by providers as valuable discussion and contribution. If a provider throws a lot of statistics or mental health jargon at you and/or you start to feel fearful, pause and remember that you don’t have to make big decisions or reason with them from this place.
Understand what the providers’ goals are for your child. Sometimes, a provider’s goal is symptom reduction – and that may be appropriate. But be sure they are also exploring and trying to get to the bottom of what is really going on. Providers should be exploring the circumstances causing these challenges, and supporting caregivers in developing parenting skills to best support their child as well.
Ask the treatment team how they measure success or progress. How do we know when there is progress or challenges? Do they use certain tools to measure, scale, and assess?
Shop around for the right program and provider. It can be worth waiting for the right fit instead of jumping for what’s most in reach.
Be aware of polypharmacy (when one medication is prescribed and then another to counteract side effects and then another to manage those side effects). Sometimes side effects become a whole new diagnosis and this cascade can be difficult to see and/or stop. A cocktail of prescriptions can become dangerous and can inhibit healing, so ask the psychiatrist for details if you believe too many prescriptions are being given to your child.
Get Informed Consent. Informed consent means you are legally entitled to know the intended positive effects of treatment, potential adverse reactions to treatment, and alternatives to treatment. In some states, your child, even as a minor, has this right. If providers are unwilling to share answers or avoid answering, this can be a problem.
You are allowed to SAY NO to any recommended treatment.
Gather your team. Sometimes, residential treatment centers are staffed by relatively inexperienced counselors who are still learning. Turnover rates can be high, as the work is hard and often underappreciated. There are also incredibly talented and dedicated counselors. If possible, find the counselor who has connected with your kid on a meaningful level and ask that they be a part of treatment meetings. They can provide insight that not even the licensed therapists can see, as the counselors witness the kids in their daily treatment lives, not just in the therapy room.
Don’t be shy about exercising your rights to gather information, advocate, stand your ground, and explore alternatives.
As you go through this process with your child, you will inevitably manage lots of transitions – it might be the transition from home to a wilderness program; then from wilderness to residential treatment or a therapeutic boarding school. It might be a transition from a residential treatment program or therapeutic boarding school to a young adult program if you child is not ready to come home or live independently but has “aged out” – meaning they have turned 18 and can no longer be in a program with kids under 18. All of those transitions are fraught with stress – both for the child and for the family. For the child, it is the uncertainty of knowing what the next program will be like and what the other kids or staff will be like. It may also be anger that they can’t just come home already. For the parents, it is the stress of having to start all over, looking into programs and trying to figure out which one is best suited for your child and family and never being sure you have made the right choice.
There are no magic answers for how best to navigate these transitions. See our Transitions page for more info.
Young Adults (over 18)
There are residential programs designed for young adults. Of course, unless you have a guardianship, your child now has the legal right to refuse to go. Search our Directory of programs for young adult programs.
At these programs, expect far less parental involvement. The staff will work with your child to come up with a schedule that your child will help craft – be it getting a job nearby or signing up for classes or some combination thereof. They may help your child find a local therapist who can continue to work with them. The goal of these programs is to help your child build up the skills they will need to transition to more independent living – be it budgeting or cleaning or grocery shopping and cooking. See our transitioning to a young adult program for more.
Absolutely. The programs will typically help your young adult enroll in a local community college or online courses.
It varies by program, but typically, a young adult can stay in a program for many years. The goal is to get your child to a place where they can live more independently. For some young adults, that might be a year. For others, it may be several years.
Additional Considerations
Many programs will accommodate and be inclusive to physical needs and disabilities. Some will fit programmatically better than others; for example, wilderness therapy which includes extensive hiking and backpacking will likely not be appropriate if the disability impacts walking. It will be necessary to gather as much information as possible from admissions representatives and visit the campus to sense if your child will be supported.
Ask questions like:
-What support and accommodations do you provide for ________ condition?
-What kind of assistive technology do you provide?
-What does the accommodation process look like?
-Have you had students with this condition before? If so, what was their experience?
-How many students with this disability do you serve?
-What training is provided to staff regarding supporting individuals with physical disabilities?
For more information, contact the ADA national network 800-949-4232 (Voice or TTY)
https://adata.org/guide/americans-disabilities-act-questions-and-answers
-If the court is ordering a placement, ask for placement options, names, and the facility and ask your assessment questions. The court may not give you many options, but it is worth trying to assess what treatment is best. Working with the counselor, court officer, and attorney will be useful in getting information about the placement order to find the best care possible. You will still have to look into your insurance plan and advocate for the state to cover costs, particularly if court-ordered.
-If the court is ordering juvenile hall, you can also utilize your team to advocate for either local mental health treatment or residential facilities instead. In this case, you will likely have to prove that the crime committed is related to mental health and that residential treatment is the way to treat the underlying cause of the crime.
-If your child has a mental health diagnosis and is able to meet strict criteria, the cost may be handled by the state’s department of mental health, and residential treatment will likely be paid through Medicaid or other state funding.
-If the crime is related to drug offenses, there may be court-ordered drug rehabilitation treatment options as well.
-Court Appointed Special Advocates (CASA) are trained volunteers to help advocate for youth in the foster care system and exist in most states. If it’s a good fit, they can be a helpful resource in navigating these systems.
-Here is the federal program Substance Abuse and Mental Health Services Administration (SAMHSA) directory of state-run facilities:
https://www.samhsa.gov/data/report/2019-national-directory-mental-health-treatment-facilities–
-Here is the SAMHSA early serious mental health treatment locator: https://www.samhsa.gov/esmi-treatment-locator
Some parents may voluntarily place their child in foster care if they do not feel safe living with their child, or for other reasons. If foster care can’t find a placement, the child may be sent to a group home or residential facility. However, depending on the state, there are different shifting laws around group homes; for example, many in California are closing with the hope of keeping more youth in-home and increasing referrals to mental health services within the local community.
